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Mezaache S, Protopopescu C, Debrus M, Morel S, Mora M, Suzan-Monti M, Rojas Castro D, Carrieri P, Roux P. Changes in supervised drug-injecting practices following a community-based educational intervention: A longitudinal analysis. Drug Alcohol Depend 2018; 192:1-7. [PMID: 30195241 DOI: 10.1016/j.drugalcdep.2018.07.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/24/2018] [Accepted: 07/26/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND People who inject drugs face several health issues because of unsafe injecting practices. We aimed to evaluate changes in supervised drug-injecting practices following the implementation of a face-to-face educational intervention. METHODS The national study ANRS-AERLI was conducted in 17 harm reduction (HR) facilities in France between 2011 and 2013. Eight offered the intervention and nine did not. We conducted a pre-post analysis focusing on injecting practices data, collected in the 8 HR facilities providing the intervention. The intervention consisted of providing face-to-face educational sessions including direct observation of injecting practices, counseling about safer injecting, and shared discussion. Injecting practices were collected following a checklist and classified as safe or unsafe. To assess changes in injecting practices, practices were compared before (at baseline) and after at least one educational session. FINDINGS Mixed logistic models showed that the 78 participants included were more likely to improve in the following drug-use steps: setting up a clean preparation area (Adjusted Odds Ratio (AOR) = 3.4, 95% Confidence Interval (95% CI) = 1.6-7.6), hand washing (AOR = 7.2, 95% CI = 3.1-16.4), skin cleaning (AOR = 5.6, 95% CI = 2.5-12.1), choice of safe injection site (AOR = 6.5, 95% CI = 1.5-28.8) and post-injection bleeding management (AOR = 12.8, 95% CI = 5.5-29.9). Furthermore, participants were less likely to lick their needles before injecting (AOR = 8.1, 95% CI = 1.5-43.4) and to perform booting/flushing (AOR = 2.5, 95% CI = 1.2-5.3). CONCLUSIONS The AERLI intervention seems to be effective in increasing safe drug-injecting practices.
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Affiliation(s)
- Salim Mezaache
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire Régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France.
| | - Camélia Protopopescu
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire Régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | | | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire Régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Marie Suzan-Monti
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire Régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France; AIDES, Pantin, France
| | - Daniel Rojas Castro
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire Régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France; Groupe de Recherche en Psychologie Sociale (EA 4163), Université Lyon 2, Bron, France; Coalition Plus, Pantin, France
| | - Patrizia Carrieri
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire Régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Perrine Roux
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France; ORS PACA, Observatoire Régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
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Eldridge SM, Lancaster GA, Campbell MJ, Thabane L, Hopewell S, Coleman CL, Bond CM. Defining Feasibility and Pilot Studies in Preparation for Randomised Controlled Trials: Development of a Conceptual Framework. PLoS One 2016; 11:e0150205. [PMID: 26978655 PMCID: PMC4792418 DOI: 10.1371/journal.pone.0150205] [Citation(s) in RCA: 719] [Impact Index Per Article: 89.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 02/10/2016] [Indexed: 12/18/2022] Open
Abstract
We describe a framework for defining pilot and feasibility studies focusing on studies conducted in preparation for a randomised controlled trial. To develop the framework, we undertook a Delphi survey; ran an open meeting at a trial methodology conference; conducted a review of definitions outside the health research context; consulted experts at an international consensus meeting; and reviewed 27 empirical pilot or feasibility studies. We initially adopted mutually exclusive definitions of pilot and feasibility studies. However, some Delphi survey respondents and the majority of open meeting attendees disagreed with the idea of mutually exclusive definitions. Their viewpoint was supported by definitions outside the health research context, the use of the terms 'pilot' and 'feasibility' in the literature, and participants at the international consensus meeting. In our framework, pilot studies are a subset of feasibility studies, rather than the two being mutually exclusive. A feasibility study asks whether something can be done, should we proceed with it, and if so, how. A pilot study asks the same questions but also has a specific design feature: in a pilot study a future study, or part of a future study, is conducted on a smaller scale. We suggest that to facilitate their identification, these studies should be clearly identified using the terms 'feasibility' or 'pilot' as appropriate. This should include feasibility studies that are largely qualitative; we found these difficult to identify in electronic searches because researchers rarely used the term 'feasibility' in the title or abstract of such studies. Investigators should also report appropriate objectives and methods related to feasibility; and give clear confirmation that their study is in preparation for a future randomised controlled trial designed to assess the effect of an intervention.
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Affiliation(s)
- Sandra M. Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London, United Kingdom
- * E-mail:
| | - Gillian A. Lancaster
- Department of Mathematics and Statistics, Lancaster University, Lancaster, Lancashire, United Kingdom
| | - Michael J. Campbell
- School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, United Kingdom
| | - Lehana Thabane
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Claire L. Coleman
- Centre for Primary Care and Public Health, Queen Mary University of London, London, United Kingdom
| | - Christine M. Bond
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, Scotland, United Kingdom
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Phillips KT. Barriers to practicing risk reduction strategies among people who inject drugs. ADDICTION RESEARCH & THEORY 2015; 24:62-68. [PMID: 27499724 PMCID: PMC4972039 DOI: 10.3109/16066359.2015.1068301] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION AND AIMS People who inject drugs (PWID) engage in practices that put them at risk for various infections and overdose. The primary aim of this study was to examine common barriers to engaging in two risk reduction practices - cleaning one's skin at the injection site and always using new needles to inject - among heroin injectors in Denver, CO. METHOD In 2010, 48 PWIDs were recruited through street outreach and completed a structured interview that included questions on the frequency of specific risk reduction practices (skin cleaning and using new needles) and barriers associated with these practices. RESULTS Though many of the reported barriers were similar across the two practices, the most common barriers associated with skin cleaning included being in withdrawal and not being prepared with materials prior to injection. Fear of being arrested and being in withdrawal were most frequently reported for using new needles. Multivariate and t-test analyses demonstrated that individuals who skin cleaned and used new needles more frequently reported less barriers to these practices. CONCLUSIONS Participants reported a number of barriers to risk reduction, including those that are within the personal control of the injector, barriers that are consequences of addiction or psychological problems, and those that are structural or a function of the risk environment. Statistical analysis found that PWIDs who were more likely to skin clean and use new needles reported less barriers. Addressing barriers when intervening with PWID appears important to increase the success of risk reduction interventions.
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Affiliation(s)
- Kristina T Phillips
- School of Psychological Sciences, University of Northern Colorado, Greeley, CO, USA
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Bonar EE, Rosenberg H. Injection Drug Users' Perceived Barriers to Using Self-Initiated Harm Reduction Strategies. ADDICTION RESEARCH & THEORY 2014; 22:271-278. [PMID: 25419201 PMCID: PMC4238385 DOI: 10.3109/16066359.2013.838225] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
INTRODUCTION AND AIMS Increasing the frequency with which injecting drug users (IDUs) engage in self-initiated harm reduction strategies could improve their health, but few investigations have examined IDUs' perceived barriers to engaging in these behaviors. METHOD We interviewed 90 IDUs recruited from needle exchanges to assess: a) perceived obstacles to their use of two specific harm reduction strategies (i.e., test shots and pre-injection skin cleaning) designed to reduce two unhealthy outcomes (i.e., overdose and bacterial infections, respectively) and b) their use of other risk-reduction practices. RESULTS The most frequently cited barrier for both test shots and skin cleaning was being in a rush to inject one's drugs. Other, less commonly cited barriers were strategy-specific (e.g., buying drugs from a known dealer as a reason not to do a test shot; not having access to cleaning supplies as a reason not to clean skin). Regarding other risk reduction practices, participants' most frequently reported using new or clean injecting supplies and avoiding sharing needles and injecting supplies. DISCUSSION AND CONCLUSIONS Some, but not all, of the barriers generated by participants in our study were similar to those frequently reported in other investigations, perhaps due to differences in the type of sample recruited or in the harm reduction behaviors investigated.
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Affiliation(s)
- Erin E Bonar
- University of Michigan, Addiction Research Center, 4250 Plymouth Road, Ann Arbor, MI 48109-0720
| | - Harold Rosenberg
- Bowling Green State University, Department of Psychology, Bowling Green, OH 43403
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MacArthur GJ, van Velzen E, Palmateer N, Kimber J, Pharris A, Hope V, Taylor A, Roy K, Aspinall E, Goldberg D, Rhodes T, Hedrich D, Salminen M, Hickman M, Hutchinson SJ. Interventions to prevent HIV and Hepatitis C in people who inject drugs: a review of reviews to assess evidence of effectiveness. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 25:34-52. [PMID: 23973009 DOI: 10.1016/j.drugpo.2013.07.001] [Citation(s) in RCA: 212] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 06/25/2013] [Accepted: 07/03/2013] [Indexed: 01/23/2023]
Abstract
BACKGROUND Injecting drug use is a major risk factor for the acquisition and transmission of HIV and Hepatitis C virus (HCV). Prevention of these infections among people who inject drugs (PWID) is critical to reduce ongoing transmission, morbidity and mortality. METHODS A review of reviews was undertaken involving systematic literature searches of Medline, Embase, CINAHL, PsychINFO, IBSS and the Cochrane Library (2000-2011) to identify English language reviews regarding the effectiveness of harm reduction interventions in relation to HIV transmission, HCV transmission and injecting risk behaviour (IRB). Interventions included needle and syringe programmes (NSP); the provision of injection paraphernalia; opiate substitution treatment (OST); information, education and counselling (IEC); and supervised injecting facilities (SIFs). Reviews were classified into 'core' or 'supplementary' using critical appraisal criteria, and the strength of review-level evidence was assessed. RESULTS Twelve core and thirteen supplementary reviews were included. From these reviews we identified: (i) for NSP: tentative review-level evidence to support effectiveness in reducing HIV transmission, insufficient review-level evidence relating to HCV transmission, but sufficient review-level evidence in relation to IRB; (ii) for OST: sufficient review-level evidence of effectiveness in relation to HIV transmission and IRB, but tentative review-level evidence in relation to HCV transmission; (iii) for IEC, the provision of injection paraphernalia and SIFs: tentative review-level evidence of effectiveness in reducing IRB; and either insufficient or no review-level evidence for these interventions in relation to HIV or HCV transmission. CONCLUSION Review-level evidence indicates that harm reduction interventions can reduce IRB, with evidence strongest for OST and NSP. However, there is comparatively little review-level evidence regarding the effectiveness of these interventions in preventing HCV transmission among PWID. Further studies are needed to assess the effectiveness and impact of scaling up comprehensive packages of harm reduction interventions to minimise HIV and HCV transmission among PWID.
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Affiliation(s)
- Georgina J MacArthur
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
| | - Eva van Velzen
- NHS Sutton and Merton/London KSS Specialty School of Public Health, UK
| | | | - Jo Kimber
- University of New South Wales, Sydney, Australia
| | | | - Vivian Hope
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK; Health Protection Services, Health Protection Agency, London, UK
| | - Avril Taylor
- University of the West of Scotland, Paisley, Scotland, UK
| | | | - Esther Aspinall
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | | | - Tim Rhodes
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK
| | - Dagmar Hedrich
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Mika Salminen
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Sharon J Hutchinson
- Health Protection Scotland, Glasgow, UK; University of the West of Scotland, Paisley, Scotland, UK
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Phillips KT, Altman JK, Corsi KF, Stein MD. Development of a risk reduction intervention to reduce bacterial and viral infections for injection drug users. Subst Use Misuse 2013; 48:54-64. [PMID: 23017057 PMCID: PMC4868543 DOI: 10.3109/10826084.2012.722159] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Bacterial infections are widespread problems among drug injectors, requiring novel preventive intervention. As part of a NIDA-funded study, we developed an intervention based on the Information-Motivation-Behavioral Skills model, past research, injection hygiene protocols, and data collected from focus groups with 32 injectors in Denver in 2009. Qualitative responses from focus groups indicated that most participants had experienced skin abscesses and believed that bacterial infections were commonly a result of drug cut, injecting intramuscularly, and reusing needles. Access to injection supplies and experiencing withdrawal were the most frequently reported barriers to utilizing risk reduction. Implications for intervention development are discussed.
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Affiliation(s)
- Kristina T Phillips
- School of Psychological Sciences, University of Northern Colorado, Greeley, Colorado 80639, USA.
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Phillips KT, Stein MD, Anderson BJ, Corsi KF. Skin and needle hygiene intervention for injection drug users: results from a randomized, controlled Stage I pilot trial. J Subst Abuse Treat 2012; 43:313-21. [PMID: 22341554 DOI: 10.1016/j.jsat.2012.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 01/02/2012] [Accepted: 01/16/2012] [Indexed: 11/28/2022]
Abstract
A new skin and needle hygiene intervention, designed to reduce high-risk injection practices associated with bacterial and viral infections, was tested in a pilot, randomized controlled trial. Participants included 48 active heroin injectors recruited through street outreach and randomized to either a 2-session intervention or an assessment-only condition (AO) and followed up for 6 months. The primary outcome was skin- and needle-cleaning behavioral skills measured by videotaped demonstration. Secondary outcomes were high-risk injection practices, intramuscular injection, and bacterial infections. Intervention participants had greater improvements on the skin (d = 1.00) and needle-cleaning demonstrations (d = .52) and larger reductions in high-risk injection practices (d = .32) and intramuscular injection (d = .29), with a lower incidence rate of bacterial infections (hazard ratio = .80), at 6 months compared with AO. The new intervention appears feasible and promising as a brief intervention to reduce bacterial and viral risks associated with drug injection.
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Affiliation(s)
- Kristina T Phillips
- University of Northern Colorado, School of Psychological Sciences, Greeley, CO 80639, USA.
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Rodríguez-Díaz CE, Reece M, Rivera-Alonso B, Laureano-Landrón I, Dodge B, Malow RM. Behind the Bars of Paradise: HIV and Substance Use among Incarcerated Populations in Puerto Rico. ACTA ACUST UNITED AC 2011; 10:266-72. [PMID: 21460352 DOI: 10.1177/1545109711398664] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
For those who are incarcerated in jails and prisons, the correctional setting represents a unique context for health care access and utilization. In Puerto Rico, over 16 000 persons pass each year through a correctional facility, approximately 6.9% of the incarcerated population present HIV infection, and 73.8% and 27.1% evidence a previous history of drug and alcohol use, respectively. In addition, HIV-infected populations have comorbidity with other diseases that are associated with substance use. Several approaches have been considered to prevent, treat, and provide a continuum of care for HIV and substance disorders among incarcerated populations. Nearly 30 years of legally regulated practices for correctional health care have produced recommendations for addressing the needs of those with HIV and substance disorders within the correctional facilities in Puerto Rico. These recommendations include making prevention services available, building capacity among health care providers, and understanding the cultural and political contexts.
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Gillies M, Palmateer N, Hutchinson S, Ahmed S, Taylor A, Goldberg D. The provision of non-needle/syringe drug injecting paraphernalia in the primary prevention of HCV among IDU: a systematic review. BMC Public Health 2010; 10:721. [PMID: 21092300 PMCID: PMC3001732 DOI: 10.1186/1471-2458-10-721] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 11/23/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sharing drug injecting paraphernalia other than needles and syringes (N/S) has been implicated in the transmission of Hepatitis C virus (HCV) among injecting drug users (IDU). We aimed to determine whether the provision of sterile non-N/S injecting paraphernalia reduces injecting risk behaviours or HCV transmission among IDU. METHODS A systematic search of seven databases and the grey literature for articles published January 1989-February 2010 was undertaken. Thirteen studies (twelve observational and one non-randomized uncontrolled pilot intervention) were identified and appraised for study design and quality by two investigators. RESULTS No studies examined the association between the provision of non-N/S injecting paraphernalia and incident HCV infection. One cross-sectional study found that individuals who frequently, compared to those who infrequently, used sterile cookers and water, were less likely to report prevalent HCV infection. Another found no association between the uptake of sterile non-N/S injecting paraphernalia and self-reported sharing of this paraphernalia. The remaining observational studies used attendance at needle and syringe exchange programmes (NSP) or safer injection facilities (SIF) that provided non-N/S injecting paraphernalia as a proxy measure. Eight studies presented adjusted odds ratios, ranging from 0.3 to 0.9, suggesting a reduced likelihood of self-reported sharing of non-N/S injecting paraphernalia associated with use of NSP or SIF. There was substantial uncertainty associated with these estimates however. Three unadjusted studies reported a reduction in the prevalence of sharing of non-N/S injecting paraphernalia over time among NSP users. Only one study reported an adjusted temporal trend in the prevalence of sharing non-N/S injecting paraphernalia, finding higher rates among non-NSP users than NSP users at each time point, and a greater reduction in sharing among non-NSP than NSP users over time. Study limitations included the use of convenience samples, self-reported exposure and outcome measures, flawed classification of the exposed and unexposed groups, and inadequate adjustment for potential confounding variables. CONCLUSIONS The evidence to demonstrate that the provision of sterile non-N/S injecting paraphernalia reduces HCV transmission or modifies injecting risk behaviours is currently limited by an insufficient volume and quality of studies. Further research is required to inform practice and policy in this area.
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Affiliation(s)
- Michelle Gillies
- Department of Public Health-Faculty of Medicine, University of Glasgow, G128QR UK.
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